Provider Demographics
NPI:1700801081
Name:STUK, JEFFREY L (DO)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:L
Last Name:STUK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5617
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-0617
Mailing Address - Country:US
Mailing Address - Phone:989-401-4245
Mailing Address - Fax:989-401-4235
Practice Address - Street 1:1309 SHELDON RD
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2404
Practice Address - Country:US
Practice Address - Phone:616-847-5232
Practice Address - Fax:616-847-5231
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010116332085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3463196Medicaid
MI3463196Medicaid
MI0F16017007Medicare ID - Type Unspecified